THORAX AND MAMMOGRAFI

USA
The mediastinal shadow is
dominated by the
dilation of the aorta.
NoteCOMMENTS
that as the
descending aorta on
the left approaches
the diaphragm, it
begins to lie more
centrally. Better
definition of the aortic
anatomy is achieved
with the CT scan
during which iodinated
contrast material was
injected to opacify the
blood pool in the
dilated aorta.
 Forty-eight year-old male
with longstanding moderately
severe aortic insufficiency
due to past endocarditis.
When the volume of the
regurgitant fraction is
significant, there is
COMMENTS enlargement of the left
ventricle and, therefore, a
globular widening of the
cardiac silhouette.
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 COMMENTS

This radiograph shows increased

density of the left hemithorax
obscuring the left heart border. Note
that the opacification extends from
the upper portion of the thorax to at
least the hilar level. Loss of the
cardiac boundary indicates that the
heart and the infiltrated collapsed
left upper lobe (including the
lingula) are immediately adjacent
and therefore no distinct left
boundary of the heart is defined.
Atelectasis is the loss of lung volume
and therefore a direct sign is the
displacement of interlobular fissures.
Generally this is accompanied by
increased density and possibly elevation
of the hemidiaphragm, mediastinal
displacement, or compensatory over-
inflation. If there has been resorption of
air within the atelectatic segment, there
is generally an absence of air
bronchograms.
Atelectasis is the loss of lung
volume and therefore a direct sign
is the displacement of interlobular
fissures. Generally this is
accompanied by increased density
and possibly elevation of the
hemidiaphragm, mediastinal
displacement, or compensatory
over-inflation. If there has been
resorption of air within the
atelectatic segment, there is
generally an absence of air
bronchograms.
These images arise from a
forty-two year-old male with
progressive dyspnea on
exercise over a two-year period.
The patient had a strong family
history of cardiomyopathy with
two of three siblings who died in
their 30's of idiopathic
cardiomyopathic disorders. The
cardiomegaly visible on this
frontal chest film was not
present on a film taken two
years before but became
progressive as shown by the
film of just two months previous
The PA (postero-anterior)
radiograph is only very subtly
abnormal in the mediastinum.
Looking through the central
mediastinal density there is a
suggestion of air and possibly an
air fluid level in the region medial
to the descending aorta.
(Incidentally noted is a central
venous line entering under the
right clavicle and terminating in
the superior vena cava). The CT
scan is definitive and shows
clearly the air-filled dilated
esophagus posterior to the
trachea. Radiodense fluid such as
barium defines the esophageal
space and its dilatation.
These images arise from a forty-
two year-old male with progressive
dyspnea on exercise over a two-
year period. The patient had a
strong family history of
cardiomyopathy with two of three
siblings who died in their 30's of
idiopathic cardiomyopathic
disorders. The cardiomegaly visible
on this frontal chest film was not
present on a film taken two years
before but became progressive as
shown by the film of just two
months previous
The tumor is relatively
easily visible because of
its microcalcifications,
although the boundary of
the tumor mass is not so
well defined. The
presence of the
calcifications are so
strikingly abnormal and
fine in structure that the
diagnosis of malignancy
can be made with high
certainty.
 A benign fibroadenoma of the
breast is distinguished by its
sharp margins and lack of
microcalcifications.
There is no skin retraction or
extensions into the parenchymal
tissue.
Malignant masses are often
characterized by irregular
tented boundaries with
retraction of other fibrous
structures and may be
accompanied by local skin
thickening or
microcalcifications.
 A cluster of very small
microcalcifications with or without
increased local density of the
breast is an important image finding
indicating malignancy.
The finding merits specific attention
even if it is not accompanied by any
other of the typical carcinomatous
findings such as skin retraction or
irregular mass boundar
Not uncommonly melanoma
may seed metastases to the
mediastinum and lungs. The
X-ray alone may have
difficulty discriminating the
boundaries of normal and
abnormal tissues. Further
evaluation often requires a
tomographic technique such
as CT or MRI.
In this X-ray of a 65 year old
male presenting with cough and
weight loss, there was found a
right lung mass.The lung mass
appears in the medial portion of
posterior segment of RUL,
contiguous with right hilum and
obscuring the boundary with the
aortic knob on the right. Also,
lymphadenopathy in right
paratracheal, pretracheal, and
subcarinal spaces are present.
The findings of mediastinal
masses should be
distinguished from
enlargement of either the
heart or aorta. Mediastinal
masses need not be
symmetric but commonly
they will occur beyond the
usual limits of the normal
mediastinal segments.
Mediastinal masses are
generally classified by their
presence in either the
anterior, middle or
posterior mediastinum.
Anterior mediastinal
masses can include
thymomas, whereas
middle mediastinal masses
are dominated by
lymphomas and lymphatic
spread of tumors. Posterior
mediastinal masses may
often be of neural origin.
Location of these masses
often requires the lateral x-
ray and conventionally will
include either computed
tomography or magnetic
resonance imaging (MRI)
for further evaluation.
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PA (posterior-anterior) radiograph
shows ellipsoidal enlargement of the
right hilar structures that differ from
the normal branching pattern of the
vasculature and therefore represent
enlarged hilar lymph nodes. Careful
search of the lung fields for a
potential primary is indicated, but
this individual showed no evidence
of other lung mass or pathology and
the right hilar adenopathy was
determined to have originated as
metastases from an abdominal
This PA radiograph demonstrates a
large wedge-shaped density in the right
middle lobe. Also note a coin lesion at
the right costophrenic angle. The right
middle lobe large density on biopsy was
determined to be a metastasis from
cervical carcinoma. Note that the sharp
upper boundary of the right middle lobe
triangular mass is the right middle lobe
fissure. In addition, there is
enlargement of the right hilar structures
due to metastases within the hilar
lymph nodes.